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TRANSCRIPT
What Matters Most: Quality Measurement from the Person’s Perspective
Grantmakers In Aging - Annual ConferenceOctober 19, 2017
Session Goals
1. Introduction to the “Essential Attributes of a High-Quality System of Care for Adults with Complex Care Needs.”
1. Presentation of current quality measurement work that aims to advance the Essential Attributes.
1. Discussion of how the Essential Attributes are being used at the state-level to support delivery system reform.
1. Understand how Foundations can be involved in quality measurement work and how the Essential Attributes can be used in grant-making.
Speakers
• Sarah Barth, JD
Principal
Health Management Associates
• Erin Giovannetti PhD
Senior Research Scientist
National Committee for Quality Assurance
• Alice Lind, RN, BSN, MPH
Section Manager, Grants and Program Development
Health Care Authority
Group Activity – Steps 1 and 2
• On each table there are post-it notes.
• Step 1: Write down your personal “essential attributes” of a quality system of care. (2-minutes)
• Step 2: Share your “essential attributes” with the person to your right. (2-minutes)
Group Activity – Steps 3 and 4
• Each table needs to pick a “reporter.”
• Step 3: Share your “essential attributes” with your table. Determine the table’s top 4 “Essential Attributes.” (10-minutes)
• Step 4: Table report-out and reflections from Sarah Barth.
What Matters Most:
Essential Attributes of a High-Quality System of Care for Adults with Complex Care Needs
Sarah Barth, JD
October 19, 2017
OUR FIRM
We are a leading
independent, national
healthcare research
and consulting firm
providing technical
and analytical
services.
We specialize in
publicly-funded
health programs,
system reform and
public policy.
We work with
purchasers,
providers, policy-
makers, program
evaluators, investors
and others.
Our strength is in our
people, and the
experience they bring
to the most complex
issues, problems, or
opportunities.
7
ESSENTIAL ATTRIBUTES WORKING GROUP
✚The SCAN Foundation convened diverse experts representing the interests of adults with complex care needs
✚Federal officials working on relevant programs and representatives of other foundations with related interests participated as ex-officio members
8
WORKING GROUP GOAL
Develop consensus on the Essential Attributes of a high-quality system of care that supports system transformation and evaluation, and is from the
vantage point of adults with complex care needs
9
WORKING GROUP PROCESS
✚Included: ✚A comprehensive literature review
✚Individual interviews with each working group member and select ex-officio members
✚Three meetings of the working group and ex-officio members to develop consensus around the Essential Attributes
✚Identified the importance of formalizing approaches to considering the needs of family/caregivers as essential
10
WORKING GROUP MEMBERS
Name Role, Agency
G. Lawrence Atkins Executive Director, Long Term Quality Alliance
Melanie Bella Independent Consultant
Rich Bringewatt Co-Founder & CEO, National Health Policy GroupCo-Founder & Chair, SNP Alliance
Helen Burstin Chief Scientific Officer, National Quality Forum
Jennifer Dexter Assistant Vice President, Government Relations, Easter Seals
Lynn Friss Feinberg Senior Strategic Policy Advisor, AARP Public Policy Institute
Allison Hamblin Vice President for Strategic Planning, Center for Health Care Strategies, Inc.
Jennifer Goldberg Directing Attorney, Justice in Aging
Alice Lind Manager, Grants and Program Development, Washington State Health Care Authority
Debra Lipson Senior Fellow, Mathematica Policy Research
Deidre Gifford Director of State Policy and Programs, National Association of Medicaid Directors
Margaret E. O’Kane President, National Committee for Quality Assurance
Pam Parker Medicare-Medicaid Integration Consultant, Minnesota Department of Human Services
Carol Regan Senior Advisor, Community Catalyst, Center for Consumer Engagement in Health Innovation
EX-OFFICIO MEMBERS & ADDITIONAL PARTICIPANTS
Name Role, Agency
Gretchen Alkema Vice President of Policy & Communications, The SCAN Foundation
Eliza Navarro Bangit Director, Office of Policy Analysis and Development, Administration for Community Living,Department of Health and Human Services (HHS)
Stephen Cha Director, State Innovations Group, Centers for Medicare & Medicaid Services (CMS)
Bruce Chernof President & CEO, The SCAN Foundation
Tim Englehardt Director, State Innovations Group, CMS
Marcus Escobedo Senior Program Officer, The John A. Hartford Foundation
Susan Mende Senior Program Officer, Robert Wood Johnson Foundation
MaryBeth Musumeci Associate Director, Kaiser Commission on Medicaid and the Uninsured
Lisa Patton Division Director, Center for Behavioral Health Statistics & Quality, Substance Abuse and Mental Health Services Administration (SAMHSA)
Nidhi Singh Shah Health Policy Analyst, CMS/Center for Clinical Standards and Quality
Stephanie Gibbs Senior Program Officer, Center for Health Care Strategies, Inc.
Erin Giovanetti Research Scientist, Performance Management, National Committee for Quality Assurance
Ann Hwang Director, Community Catalyst, Center for Consumer Engagement in Health Innovation 12
EX-OFFICIO MEMBERS & ADDITIONAL PARTICIPANTS
Name Role, Agency
Wally Patawaran Program Officer, The John A. Hartford Foundation
Kali Peterson Program Officer, The SCAN Foundation
Diane Rowland Executive Vice President, Kaiser Family FoundationExecutive Director, Kaiser Commission on Medicaid and the Uninsured
René Seidel Vice President of Programs and Operations, The SCAN Foundation
Emily Zyborowicz Manager, Research & Identification, Peterson Center of Healthcare
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WORKING GROUP SIGN-ON
Affirm their support and commit to advancing the Essential Attributes produced
through the consensus process
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✚Individuals are able to live their lives with services and supports reflecting their values and preferences in the least restrictive, most independent setting possible with access to a delivery system that respects and supports their choices and decisions
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ESSENTIAL ATTRIBUTES OVERARCHING GOAL STATEMENT
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HIGH-QUALITY SYSTEM FOR ADULTS WITH COMPLEX CARE NEEDS
ATTRIBUTE 1
17
ATTRIBUTE 2
18
ATTRIBUTE 3
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ATTRIBUTE 4
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ESSENTIAL ATTRIBUTES
• Support system transformation and evaluation, as well as core elements in the functioning of such a system
• Help guide future efforts to develop quality measures that capture the goals, preferences, and desired life outcomes of adults with complex care needs
The Essential
Attributes aim to:
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Developing Person-Driven Outcomes
Erin Giovannetti, Ph.D.
Senior Research Scientist
Health and Quality of Life
Goals
ValuesCare
Preferences
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What Matters Most?Findings from Focus Groups with Disabled Older Adults
Stop falling as much
Lose weight
Take fewer
medications
Avoid dialysis
Stay out of the
hospitalStay in my home
Choose who helps
me dress and bathe
Increase mobility and
stamina
Manage symptoms
Play with my
grandchildren
Have privacy
Choose who cares
for me in my homeGet my doctors to
talk to each other
Be heard by my
doctors
Stay sharp
Caregiver
Goals
Help my caregiver be
less stressed
Not be a burden to
my family
Person-Driven OutcomesIndividualized outcomes identified by
the patient (or caregiver) as important
that can be used for care planning and
quality measurement
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Each individual’s range
of need and goals, both
medical and non-
medical, as well as for
family/caregivers are
identified and re-
evaluated on an ongoing
basis to drive care plans
Each individual’s needs
are addressed in a
compassionate,
meaningful, and person-
focused way and
incorporated into a care
plan that is tailored, safe
and timely.
Attribute #1 Attribute #2
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• The more significant the
disability the more likely
that control is vested in
others
• People tend to express
different goals depending
on who they’re talking to
• Developed goal inventory
to help start the
discussion
Step 1: Eliciting what is importantWhat is important TO somebody
instead of what is important FOR
somebody
-2
Much less
than
expected
-1
Current
State (Less
than
expected)
0
Expected
level
+1
Somewhat
better than
expected
+2
Much better
than expected
GOAL: To be
strong and
healthy
enough to fly
to California
to visit family
(daughter
and her
fiancé and
son’s family)
by winter
2016
To not be
able to
resume
driving and
not be able
to fly to
California
To have
complications
from surgery
and not drive
for at least 3
months and
not make it to
California for
the holidays
To resume
driving in 6
weeks and
fly to
California to
visit family
for the
holidays
To resume
driving in 4
weeks and fly
to California in
time for
Thanksgiving
To resume
driving in 4
weeks and
return with
daughter to
California in
October
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Option 1: Goal Attainment Scaling
27
Option 2: Prioritized Person Reported Outcome Measures
Health Care Task Difficulty
Choice and Control
Community Inclusion
Ability to participate in
social roles and activities
Companionship
Depression
Anxiety
Sleep
Pain
Cognition
Access to Services and
Supports
Caregiver Burden
Health Care Task
Difficulty
Access to
services and
supports
% of population
“achieving”
prioritized outcome
Bank of Person-Reported
Outcome ToolsPopulation
Performance
Measure
Individual
Measurement
Sample of Goals Elicited
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To eat without worry
To get off oxygen and breath with room air only
Go to the pool one time with daughter.
Avoid hospitalizations or ED visits over the next 6 months
Identify a home provider (agency) who can stay at home with pt when
caregiver needs to attend to his own medical appts within the next 2 months.
To attend 1 lunch + 1 activity at her new senior living residence within 1
month.
Walk 5 blocks 3x/wk in 6 months
I want to get out of the house more for things other than medical appointments
Feel good about herself in spite of her pain
Practice her faith
Health Care
Utilization
Cognitive
Function
Avoiding
hospitalization
Follow up with
provider
Physical
Pain management
Walking/Standing
Weight
Health condition
management
Exercise
Sleep
Avoid falling
Psychosocial
Self
Family
Friends
Religion
Mental health
Independence
Living in the
community/at home
Leaving the house
for outings
Taking care of pet
Working/volunteering
Travel/Vacation
Learning/Skills
Caregiver
SupportDriving
What types of person-driven outcomes are identified?
Calculating quality from person-driven outcomes
“You know, you can tell
somebody what to do,
but I think you convey
better things when you
give people options to
do, find out what they
like.” – 69 year old
female patient
Results from seven pilot sites testing person-driven outcomes (N=186 patients)
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Goal
Attainment
Scaling
PROM Total
Follow-up on goal 90% 74% 87%
Goal Met 62% 55% 60%
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All of a sudden, they were totally engaged in
their healthcare. And that was new for a lot of them.
So I thought that was really cool.
– NURSE CASE
MANAGER
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I have found that in doing some of the things that we put down, there’s strength
in me.
– 64 YEAR OLD MALE
This work is supported by a grant from
The SCAN Foundation and The John A.
Hartford Foundation
Washington State’s Delivery System Reform and Person Centered
Complex Care Management
Alice Lind, ManagerGrants and Program Development, HCA October, 2017
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Essential Attributes
Attribute 1:Each individual’s range of needs and goals, both medical and non-medical, as well as for family/caregivers, are identified and re-evaluated on an ongoing basis to drive care plans.
Attribute 4:Individuals and their family/caregivers continually inform the way the delivery system is structured to ensure that it is addressing their needs and providing resources tailored to them.
Attribute 2:Each individual’s needs are addressed in a compassionate, meaningful, and person-focused way and incorporated into a care plan that is tailored, safe, and timely.
Attribute 3:Individuals have a cohesive, easily navigable delivery system so that they can get the services and information they want by themselves or with support when needed, and avoid the services they do not need or want.
Healthier Washington: The Vision
The Health Care Authority has a vision of achieving the triple aim for the citizens of Washington:
• Improve health
• Lower health care costs
• Improve the experience of care
36
Healthier Washington: Goals
HCA launched a Medicaid Transformation Demonstration in 2017, with these objectives:
• Build Health Systems and Community Capacity
• Ensure Financial Sustainability through Participation in Value-based Payment
• Deliver bi-directional Integration of physical and behavioral health
• Achieve Community-based Whole-person Care
• Improve Health Equity and Reduce Health Disparities37
Community Based Whole Person Care Projects
• Use or enhance services in the community to meet the needs of a region’s identified high-risk, high-needs target populations.
• Promote care coordination across the continuum of health for beneficiaries, ensuring those with complex health needs are connected to the interventions and services needed to improve and manage their health.
• Develop linkages between providers of care coordination by utilizing a common platform.
38
Building on Solid Ground: Health Homes
• Target population: high risk, high cost clients with complex physical and behavioral health conditions
• Started under Medicare-Medicaid Alignment Demonstration
• Now statewide, due to measurable cost-savings under the terms of the demonstration
• Every engaged client has a person-centered health action plan
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Health Homes’ Person-Centered Quality
Focus group results:
• “We set goals”; “She’s a resource person and helps me set goals.”
• “I have everything anybody could possibly want.”
• “I go outside; I go to church; I interact with my neighbors. My cholesterol was dangerously high for many years and now it’s normal.”
40
Health Homes’ Survey Results
Measures from CAHPS surveys, all 80-90%:
• Shared decision making
– Did a doctor talk to you about pros and cons of treatment
– Did a doctor ask you about which choice was best for you
• Care transition
– Hospital staff and I agreed about clear health goals
– I had all the information I needed to take care of myself
– I was confident I could actually do the things I needed to take care of myself
41
Health Homes’ Survey Results
Measures from CAHPS surveys, all 80-90%:
• Satisfaction with coordination of care
• Care plan development
• Care plan comprehensiveness
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Q & A
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The SCAN Foundation
Our Vision: A society where older adults can access health and supportive services of their choosing to meet their needs.
Our Mission: To advance a coordinated and easily navigated system of high-quality services for older adults that preserve dignity and independence.